Gleason score change from 3+4 to 3+3 with perineural invasion noted under Active Surveillance

[allshallbewell]

I recently had an MRI and PSA about 11 months into Active Surveillance. The MRI showed no change & PSA has moved from 4.2 to 3.6 to 3.1.

While a rectal biopsy done 11 months ago showed one core of Gleason 7 (3+4), I just received results of an MRI guided Transperineal Biopsy. The encouraging news us that the grades are now all Gleason 6 (3+3). The concerning news is the presence of Perineural Invasion in several cases.

Here are the specifics:

PATHOLOGIC DIAGNOSIS: A. RPZ A: Benign prostatic tissue. B. RPZ PL: PROSTATIC ADENOCARCINOMA, Gleason score 3+3=6 (Grade Group 1), involving 5% and 5% of two of two (2:2) cores. Perineural invasion is present. C. RPZ PM: PROSTATIC ADENOCARCINOMA, Gleason score 3+3=6 (Grade Group 1), involving 5% of one (1) core. Perineural invasion is present. D. LPZ A: Benign prostatic tissue. E. LPZ PL: Benign prostatic tissue. F. LPZ PM: Benign prostatic tissue. G. RPZ PM APEX: PROSTATIC ADENOCARCINOMA, Gleason score 3+3=6 (Grade Group 1), involving 20% of total tissue. Perineural invasion is present.

I just met with the medical oncologist, who seemed to be supportive of continuing with Active Surveillance. I have decided to connect with a new urologist through my team at a major medical cancer center and hope this will be in place in a matter of days if not a couple of weeks or so.

I would welcome any thoughts about how this strikes you. I am doing a lot to maximize my overall health and wellness in the past year and am committed to this path.

[Don717]

Does your MRI/Biopsy mention PV? What is your age? Also, have you had any genomic testing completed? PC run in the blood line by chance? These are all data points you can use to make the decision to treat or remain on A/S as well. All sounds good..even with the PNI. All cores are % low as well. Good on you for helping yourself too...that's big!!

[allshallbewell in reply to Don717]

Not sure re PV. Will check. Have family history but genetic test was negative. GPS number was 37 as I recall. I am 66. Otherwise in excellent health. Thanks.

[LowT]

what is the percent free PSA?

[allshallbewell in reply to LowT]

I am not familiar with the term “free PSA.”

[LowT]

it’s a lab test. “Percent free PSA”.

[allshallbewell in reply to LowT]

Thanks. Different from a regular psa?

[LowT in reply to allshallbewell]

It is PSA but it is a measurement of the percent of the PSA that is in "free" form vs the PSA that is attached to other proteins. The free form is not attached to other proteins. A ratio of these can be helpful in decision making.

[allshallbewell in reply to LowT]

Thanks!

[Tall_Allen]

I think PNI makes AS riskier:

prostatecancer.news/2018/03...

But it isn't clear that it should preclude AS entirely. Maybe get a Decipher test to help you decide.

[allshallbewell]

thanks!

[CancerConcierge]

It would be helpful to get a second opinion on the biopsy samples . John’s Hopkins is a highly recommended choice for second opinions.

Best of luck

[allshallbewell in reply to CancerConcierge]

thanks.

[lpol83712]

we would prefer no perineural invasion but it isn’t consistently called and doesn’t seem to be very important. My last biopsy at Mayo said perineural invasion present but a J Hopkins review didn’t mention it so I don’t put much stock in presence or absence. My prior first biopsy had no perineural invasion specifically noted but the review at Huntsman clinic said it was present! So two biopsies with discordant reads on perineural invasion. It doesn’t mean cancer is down the nerves a long was just potentially cancer cells were seen around some of prostate small nerves I looked at number of articles and finally decided it wasn’t the big issue it seemed